Analyst, Risk Adjustment

Oscar Health•New York, NY

2h•$75,348 - $98,894•Hybrid

About The Position

Oscar is hiring an Analyst, Risk Adjustment to support the day-to-day execution and performance of Prospective Risk Adjustment programs. Risk Adjustment accounts for differences in members’ health needs and expected cost of care; complete and accurate clinical documentation helps ensure members’ health status is appropriately represented. Prospective programs support providers in reviewing member health information and accurately documenting conditions addressed during clinical care, consistent with applicable clinical coding and documentation requirements. Program activities may include sharing relevant clinical information with providers at the point of care, conducting virtual or in-home health assessments, and providing reports that identify historical or suspected conditions for provider review and clinical validation. The Analyst partners with internal teams and external vendors to keep operational workflows functioning as intended, ensure program data and reporting are accurate, support appropriate claims processing, and identify and resolve operational issues. The role supports Point-of-Care tools, Virtual Health Assessments (VHA), In-Home Assessments (IHA), and provider reporting initiatives. It is based in Oscar’s New York, NY office and follows a hybrid schedule requiring three in-office days per week. Thursdays are required in-office; the other two office days are flexible. The role reports to the Sr. Manager, Strategic Initiatives (Risk Adjustment).

Requirements

Strong analytical and problem-solving skills, including the ability to investigate operational or data-related issues and support resolution.
Strong attention to detail and organizational skills, with the ability to manage multiple priorities and recurring deliverables.
Ability to work effectively with data, reporting tools, spreadsheets, and operational workflows.
Strong written and verbal communication skills and the ability to collaborate across teams and with external partners.

Nice To Haves

Knowledge of healthcare operations, Risk Adjustment, claims, provider operations, or health plan processes.
Experience analyzing data, identifying trends or discrepancies, and translating findings into actionable next steps.
Proficiency with Excel or Google Sheets; familiarity with SQL, Tableau, Looker, or similar analytics tools.
Work experience within a health plan, provider organization, healthcare technology company, or other healthcare environment.
Exposure to prospective Risk Adjustment programs, health assessments, Point-of-Care workflows, provider gap programs, healthcare claims, or vendor operations.
Bachelor’s degree in a healthcare, business, analytical, or related discipline preferred.

Responsibilities

Support daily operations across prospective Risk Adjustment programs, including Point-of-Care tooling, VHA, IHA, and provider gap-reporting initiatives; monitor workflows, investigate operational issues, and coordinate resolution or escalation.
Support external vendors’ day-to-day operational needs by coordinating recurring deliverables and data exchanges, responding to operational questions, tracking issues and action items, and partnering with vendors and internal stakeholders on timely resolution.
Develop and maintain recurring reports, trackers, and analyses to monitor assessment activity, provider participation, vendor performance, claims activity, and other operational metrics.
Validate and reconcile data across internal and vendor sources to identify discrepancies, trends, and opportunities for operational improvement.
Support programs that provide member health information, including historical and suspected conditions, to providers for review and clinical validation; help resolve related data, reporting, and workflow issues for Point-of-Care tools and provider reporting.
Support member-level program operations, including reviewing and processing appropriate exclusions from VHA and IHA programs.
Monitor and reconcile claims associated with prospective Risk Adjustment initiatives to ensure appropriate processing and payment; investigate discrepancies and work with relevant teams on resolution.